Provider Demographics
NPI:1558509471
Name:BELLANTONI, LEIPOLD (MD)
Entity Type:Individual
Prefix:
First Name:LEIPOLD
Middle Name:
Last Name:BELLANTONI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 N UNION AVE
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-2825
Mailing Address - Country:US
Mailing Address - Phone:410-939-3121
Mailing Address - Fax:410-939-8278
Practice Address - Street 1:308 N UNION AVE
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-2825
Practice Address - Country:US
Practice Address - Phone:410-939-3121
Practice Address - Fax:410-939-8278
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0000555174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist